Workforce — NUH (RX1)

Phase 5: medical & nursing workforce as the cross-cutting constraint. The requirement side takes the activity the other four modules say is needed — a weighted activity index deflated by a productivity lever — and asks what clinical FTE that implies. The supply side projects each staff group at its calibrated trend. The gap between them is the workforce ask hiding inside every recovery trajectory.

Seeded from the NHS Workforce Statistics HCHS CSV packs (April 2026; timeseries to 2009) — ESR payroll-based, so not EPR-affected and the latest annual pair is clean for calibration. Substantive staff only: bank and agency are outside these counts, so gaps understate true staffing pressure. Activity weights (emergency 45%, elective 35%, diagnostics 10%, cancer 10%) are a documented modelling assumption.

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Workforce position & the constraint

Where do these numbers come from?

Clinical FTE — required vs supply at trend (requirement = activity index ÷ productivity)

Productivity — the collapse and the required regain

The FTE gap above is not a hiring ask. Since 2019 the workforce grew far faster than the care it delivered — output per member of staff fell — and the recovery arithmetic only closes if part of that lost productivity is regained. This is a working-practice problem, not a chequebook problem: the 2020–24 expansion (+4.4%/yr FTE) did not buy matching activity.

RX1 productivity proxy — occupied bed-days per clinical FTE (index, 2019 = 100)

Levers

Staff groups

Staff groupFTE (Apr-26) Growth (latest yr)5-yr CAGR Required Apr-29Supply Apr-29Gap

FTE by staff group — long run (September snapshots + monthly from Apr-25)

The 2020–2024 expansion (+4.4%/yr total) has stopped: the latest year shows −1.4% total FTE, concentrated in support and infrastructure roles, while the modelled activity requirement keeps rising. Every percentage point of annual productivity (activity per FTE) substitutes for roughly a percentage point of workforce growth.

Medical workforce detail (April 2026)

Doctors by grade

GradeFTE

Consultants by specialty group

Specialty groupFTEShare